Impact of thyroid dysfunction on clinical outcome in head and neck cancer: a systematic review and meta-analysis
Bibliographic record
Abstract
Abstract Background The influence of thyroid dysfunction on the clinical outcomes of head and neck cancer (HNC) patients remains an area of ongoing investigation, with previous studies yielding variable results. Treatments for HNC, particularly radiotherapy, frequently impact thyroid function. This meta-analysis aimed to synthesize the available evidence on the association between thyroid status (dysfunction vs. euthyroid) and survival outcomes in HNC patients. Methods A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, Web of Science, Cochrane Library, Embase and Scopus were searched (January 2000-October 2024) for studies comparing survival outcomes (primarily Overall Survival) in adult HNC patients with thyroid dysfunction versus euthyroid patients. Two reviewers independently selected studies and extracted relevant data. The risk of bias for included studies was assessed using the Newcastle-Ottawa Scale (NOS) for cohort studies and the Cochrane Risk of Bias 2 (RoB2) tool for randomized controlled trials. Hazard ratios (HRs) with 95% confidence intervals (CIs) comparing survival were pooled using both fixed-effect (common-effect) and random-effects (REML) models. Heterogeneity across studies was assessed using the I² statistic and Cochran’s Q test. Statistical analyses were performed using R with the meta package. Results Six studies met the inclusion criteria for systematic review. Four of these studies, encompassing 671 participants, reported sufficient data (Hazard Ratios for Overall Survival) for meta-analysis. The fixed-effect model yielded a pooled HR of 0.99 (95% CI: 0.98, 1.00; p = 0.0013). However, significant heterogeneity was observed (I² = 81.5%, p = 0.0010). Consequently, the random-effects model, deemed more appropriate, yielded a pooled HR of 1.45 (95% CI: 0.66, 3.19; p = 0.3601), indicating no statistically significant association between thyroid status and overall survival in HNC patients. The estimated between-study variance (τ²) was 0.53. Conclusion This meta-analysis revealed substantial heterogeneity among studies investigating the impact of thyroid status on HNC survival. When accounting for this heterogeneity using a random-effects model, no significant association was found. The findings highlight the need for further research with larger sample sizes, standardized definitions of thyroid dysfunction, consistent reporting of adjusted effect estimates, and exploration of heterogeneity sources. Trial registration CRD42024535167.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.046 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.024 | 0.046 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".